Tuesday, January 2, 2018

Interoperability Predictions for 2018

As we start off the New Year, I thought I'd make some easy predictions about interoperability for 2018.  I'll do the hard ones later this week.

HL7 and FHIR

Of course I'll start with predictions for FHIR, because the first one is easy.  We'll have a dozen or so FHIR Resources reaching the status of "Standard" in 2018, probably around Q3.  HL7 is balloting FHIR this year as a standard, rather than STU for a certain subset of resources.  The ones going standard are going to be the basic set of administrative resources, as well as a few old friends.  This will include things like Patient, Practitioner, Organization, Appointment, and Encounter, and will include a few clinical resources like Observation.  This is almost a non-prediction, since Grahame Grieve has already clearly stated the plan.

FHIR STU2 will be the dominant API selection for ONC 2015 Certified products, with the largest subset of them conforming to Argonaut or being fairly close to it.  The question of Argonaut conformance will be raised given that what that means is totally unclear, and several organizations will run into issues with this.  Even the Argonaut founders aren't really clear what it means to have published a specification (I heard one last year claim that it was "balloted by HL7").  There are two versions that have been published, one in the Argonaut wiki site, and another on fhir.org.  The latter is the most well developed released.

SMART on FHIR will start on the path to become a standard this year, rather than STU.  The STU will be published later this year.

2018 will be the year that CDA on FHIR, and CCDA on FHIR become somewhat relevant to planners (vendors) of FHIR implementations.  As more products begin supporting FHIR, the need for a compatible document model will become much more apparent.

This will be the year that HL7 V3 CDA will begin its decline into oblivion, although I expect it to hang on for a few more years given that it is still required for 2015 CEHRT.


IHE will continue to adopt FHIR in its specifications.  As FHIR reaches completion, IHE focus will shift more towards trying to solve specific problems with FHIR on the clinical side.  IHE will struggle to regain focus on relevant problems as FHIR resolves more base level interoperability issues. I'm not expecting a killer profile to emerge from IHE's work this year.  QEDm will move more towards Argonaut but will not retain all of it's vocabulary.  There will continue to be overlaps and gaps in both.


On the implementation side, we'll see about a hundred vendors with certified products in 2018 providing ONC 2015 API Support.  A strong majority (75% or more) will use FHIR, a majority will use the FHIR STU2 release.

We'll see some attempt to update ONC certification requirements, but honestly, I don't expect anything more than a NPRM out of ONC this year with respect to API standards.  HL7 is on track to deliver a FHIR standard this year, but ONC won't be able to recognize it as such until it becomes available in the latter half of the year, and won't want to accept anything but the standard itself.

Certification will continue to change, some more things being relaxed, while others become more aggravating.

This will be the year that CMS FINALLY provides claims attachments regulation.  It will be based on CDA Release 2.0 and CCDA, with some additional templates.  Several thousand days late, but it least it will be a standard we can live with for five years.  It's a shame really, because if they'd just waited one more year we could do attachments in FHIR {sarcasm}.

All in all, 2018 will be an extension of 2017 with regard to Interoperability from the vendor perspective.  From the provider side we'll see the breakthrough that they've been asking for as many organizations begin adopting products that use the standards.


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